EUnetHTA Core Model Research Articles

Personalised Health Care, the need for reassessment. A HTA perspective far beyond cost-effectiveness

Background: personalised health care has been claimed to play an outstanding role in the future health services. In fact, health care systems will have to face changes in their work flows and processes due to the implementation of personalised technologies. Health Technology Assessment provides information to decision makers at any level on the introduction and exclusion of health technologies from the health care systems. Methods: the definition of Health Technology Assessment (HTA) and the concepts and questions raised in the EUnetHTA core model, were used as a framework to analyse the impact of these new services in health care provision. Results: personalised health care services and products are health technologies, mainly diagnostics that have a broad impact in the health care systems. Although, safety, clinical effectiveness and economical aspects and consequences have been described, ethical, social and organisational issues raised questions that should be answered before considering their implementation in the health systems. Special attention should be paid on new requirements for regulation, data protection and the empowerment of citizen and health professionals. Conclusions: the benefits and harms of personalised health-care technologies should be decided on a “case by case” rather than a “one size fits all” basis and has to be analysed under its many aspects. The combination of genetic, clinical and environmental factors is crucial for the correct understanding of personalised medicine and its implementation. Personalised health care will require a fine-tuned revision of existing HTA and Pharmacoeconomic’s guidelines to address its characteristics.

Integrated homecare to bridge transition from health care to social services in EU

Purpose: The fragmented delivery of health and social services for large groups of patients with chronic conditions was put on the research agenda in 2002 by WHO. The FP7-IHC-project (www.integratedhomecare.eu) aims to develop a turn-key-solution for better clinical continuity to European health regions. Method: The general framework of the project is the international concept of health technology assessment (HTA) as implemented in the EUnetHTA Core Model focusing nine analytical domains. Based on a systematic literature review of trials on integrated care integrated homecare (IHC) is defined and selected as prototype for continued rehabilitation of disabled chronic patients. Preliminary results: 1) The efficacy of IHC are hypothesized to have a common neuroeconomic explanation in the finding that the blood pressure declines 5–7 mm in your own home compared to a hospital environment which benefits limbic activity. 2) Stroke, COPD and congestive heart failure (HF) are selected as examples of IHC. Complementary trials and surveys are scheduled to consolidate a preliminary hypothesis of IHC as a health economic dominant intervention. 3) Based on a SWOT-analysis a meso-strategy implementing IHC at a regional level is planned to combine the advantages of a goal-directed centralized approach with the adaption to local conditions in a decentralized approach. Discussion: Clinical and social IHC-network-members are going to be represented as external reviewers at INIC11 in Odense before publication of the final guides and HTA-report.